Ordinary Afghans are risking their lives to visit the American military clinic in Jalalabad. Hamida Ghafour explains. Photographs by Adam Dean
Habas, 12, a young Afghan boy watches anxiously as Major Dirk Slade, an orthopaedic surgeon, removes bits of dead skin from his hand which is healing after a fire at his house. His father, equally apprehensive, looks on. Habas is one of a steady trickle of sick and wounded Afghan civilians who are treated at this clinic in FOB Fenty, an American military base in Jalalabad, eastern Afghanistan. The base is home to the 772 Forward Surgical Team, a small unit of doctors, nurses and surgeons whose primary mission is to treat American casualties of the war. But they have a secondary mission, a humanitarian one, to offer medical care to Afghans who have been hurt in the fighting or simply don't have anywhere else to turn for basic health care in the war-ravaged country. The local Jalalabad hospital has scant resources and its doctors rely on the expertise and equipment of the American army doctors.
Between one and five patients come to the American military base every day. "We do surgery, we clean up infections. We treat a lot of burns. The Afghans use fuel and propane for heating and cooking, and a lot of burns happen like that, during cooking," says Major Todd Jackson, the chief nurse. "Burns are labour-intensive, and the hospital in Jalalabad is not well equipped or set up to do [skin] grafts."
The clinic, which has been open for approximately one year, is part of the American campaign to win Afghan hearts and minds as the Taliban and their supporters march steadily across the countryside and capture more territory. There are about 60,000 soldiers in Afghanistan, the majority of them American. Later this year, an extra 30,000 soldiers are expected to arrive as part of an Iraq-style surge. There is also a plan supported by the United States to create tribal militias who can fight the Taliban, although this has caused some concern that the militias could undermine state institutions.
The insurgency is so fierce that it is preventing the Afghan government and international organisations from rebuilding and equipping hospitals in the south and eastern regions in particular. With the onset of winter, pneumonia is also a big risk. So far, six children have died in Jalalabad and as many as 3,000 have suffered from respiratory diseases over the past two months. Health problems are compounded by the fact that many people live in one-room houses and sleep close together to keep warm, thereby spreading contagious diseases.
Another common sight for the doctors at this clinic is victims of mine explosions or improvised explosive devices laid out on the roads by Taliban insurgents. In the photograph above, Major Slade examines a young man whose left leg has been amputated below the knee after one such explosion. "He had a chronic infected bone from an open fracture and his leg was not salvageable," says Major Slade. "His surgery was done by the surgeon who was posted here before me, but he was having some pain in his stump from his prosthetic so I'm following up."
Sometimes the surgeons have to amputate limbs because of common bone infections that have been left untreated. This is what might have happened to Zibi, 10, who was suffering from osteomyelitis in his right leg. "It is not uncommon for kids in the US to get bone infections," explains Major Slade. "In the States, they get treatment early - usually with antibiotics. But kids who get bone infections here tend to go untreated until the condition needs surgery."
He cleaned up Zibi's wound and gave him antibiotics. "He walked out of the clinic without crutches so that was a success story." Other ailments are heartbreakingly easy to treat. In one case, a middle-aged woman arrives with her son so she can be treated for goitre, an enlargement of the thyroid gland that is often associated with a lack of iodine in the diet. The simple remedy is to add iodine to salt, which is what the western world has been doing for a long time, where the disease has been virtually eliminated.
The doctors regularly receive donations from family and friends back home and they distribute the goods to local people. "We receive shoes, clothes, toys, and we end up with boxes of the stuff. There are a lot of good people back home. It makes it worthwhile for all of us," Major Slade says. It is perhaps a sign of how desperate Afghans are for treatment when you realise that they also risking their lives and those of their families merely by coming to the clinic. If Taliban insurgents found out they were in contact with the US military they would be accused of being collaborators and executed.
Jalalabad, which is on the border with Pakistan, is a hotbed of insurgency. Lorry drivers carrying American military supplies to Kabul on the main motorway are often shot at. Major Jackson says the military has offered to train the Afghan nurses and doctors at the local hospital, but the Afghans don't want the army to visit lest the hospital also comes under attack. Yet, he says, many of the patients are more than willing to take the risk. "When they first come they are hesitant but they are grateful. As we go on, they realise we are helping them."
